title: Transanal endoscopic microsurgery (TEM) facilitated by video-assistance and anal insertion of a single-incision laparoscopic surgery (SILS(®))-port: preliminary experience.
abstract: OBJECTIVE
  Transanal endoscopic microsurgery (TEM) is an established method for the resection of benign and early malignant rectal lesions. Very recently, TEM via an anally inserted single incision laparoscopic surgery (SILS(®))-port has been proposed to overcome remaining obstacles of the classical TEM equipment.
  
  
  METHODS
  Nine patients with a total of 12 benign or early stage malignant rectal polyps were operated using the SILS(®)-port for TEM. Patients' and polyps' characteristics, perioperative and postoperative complications, as well as operating and hospitalization time were recorded.
  
  
  RESULTS
  All 12 polyps (ten low-grade adenoma, one high-grade adenoma, one pT2 carcinoma [preoperatively staged as T1]) were resected. Local full-thickness bowel wall resection was performed for three lesions and submucosal resection for nine lesions. Median operating time was 64 (range 30-180) min. No conversion to laparoscopic or open techniques was necessary. The median maximum diameter of the specimen was 25 (range 3-60) mm, fragmentation of polyps was avoidable in 11 of 12 (92 %) lesions, and resection margins were histologically clear in 11 of 12 (92 %) polyps. Only one patient, in whom three lesions were resected, experienced a complication as postoperative hemorrhage. No mortality occurred. Median hospitalization time was four (range 1-14) days.
  
  
  CONCLUSIONS
  SILS(®)-TEM is a feasible and safe method, providing numerous advantages in application, handling, and economy compared with the classical TEM technique. SILS(®)-TEM might become a promising alternative to classical TEM. Randomized, controlled trials comparing safety and efficacy of both instrumental settings will be needed in the future.
authors.affiliation: Department of Surgery, Hospital of Liestal, Affiliated with the University of Basel, Rheinstrasse 26, 4410, Liestal, Switzerland, mikolaj.walensi@ksli.ch.
authors.forename: Mikolaj
authors.initials: M
authors.lastname: Walensi
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Käser
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Theodorou
authors.forename: Gabrio
authors.initials: G
authors.lastname: Bassotti
authors.forename: Gieri
authors.initials: G
authors.lastname: Cathomas
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Maurer
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D007417:Intestinal Polyps / Q000601:surgery*; D010535:Laparoscopy / Q000295:instrumentation*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D011446:Prospective Studies; D012002:Rectal Diseases / Q000601:surgery*